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Moving To The Rhythm
Case One:
It happened so suddenly. Young Jeremy was at bat when, without warning, he felt
weak. Then, as his parents watched helplessly, he collapsed and convulsed. The first reaction was
that Jeremy was experiencing an epileptic seizure.
But it wasn't epilepsy that caused the seizure. It was an elusive cardiac electrical abnormality
known as Long QT Syndrome. Long QT Syndrome is so uncommon, that even skilled diagnosti-
cians can be misled by the symptoms.
Case Two:
Betsy is a 23-year-old woman with no known health problems. One day she felt her
heart pounding, She felt lightheaded and nearly passed out. Her breath came in short spurts and
she had chest pain. By the time she got to the emergency room, however, Betsy felt fine again.
Betsy was told that she had suffered a panic attack. Later, she overheard someone in the room
describe her as "another dizzy chick."
WINTER 1995 ISSUE
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SINAI HOSPITAL
Setting the Pace:
High-Tech Non-Surgical
Interventions
for Clogged Arteries
A
voiding major surgery whenever an alter-
native method will do the job is a logical and
reasonable goal of modern medicine. Corn-
mitment to that goal is probably best demon-
strated in the field of cardiology, especially at Sinai.
The body's arteries can get clogged by plaque or blood
clots. Although blockage in one or more main artery
may require open-heart bypass surgery, new tech-
nologies make it possible to deal with a variety of prob-
But Betsy does not have a panic disorder. She suffers from another type of electrical dysfunc-
tion in her heart that sometimes abruptly causes it to begin beating rapidly and ineffectually.
the child of a parent with Long
QT has a 50 percent chance of
inheriting the condition. Cur-
rently, Sinai's EP (for electro-
physiology) group is studying 13
affected families from the US and
Canada — more than 200 indi-
viduals — to try to pin down the
guilty gene for further study, in
hopes of developing better diag-
nostic methods and treatment
options.
Right now, says Dr. Lehmann,
Director of Sinai's Arrhythmia
Center, it is important not to
overlook medical evaluation for
a child who passes out. A correct
diagnosis can save a life.
Sometimes heart rhythm
abnormalities masquerade as
to make a correct diagnosis,
because very often, this type of
tachycardia may be cured by per-
forming an ablation, a high-tech
procedure that destroys the small
piece of the heart muscle tissue
that causes the tachycardia.
Studies by the Sinai EP team
have also revealed another prob-
lem faced by women. It has been
found that women are more
prone than mento develop Long
QT symptoms after taking cer-
tain medications, including many
antiarrhythmic drugs, and some
antibiotics and antihistamines.
"We have only recently discovered
that women are more susceptible
to this drug-induced condition,
which can sometimes lead to
death," Dr. Lehmann
reports.
"The Sinai EP team
is recognized as one of
the top electrophysiol-
ogy groups in the
world," says Jim
Schoeck, Sinai's Vice
Russell Steinman, M.D.
co-directs Sinai's
Electrophysiology
Program and Arrhythmia
Center.
other disorders and may be mis-
understood or misdiagnosed. For
example, the Sinai EP team has
been investigating women with
symptoms of palpitations, rapid
heartbeat, lightheadedness, or
passing out who have been told
they have anxiety, panic attacks
or emotional problems. "Many of
these women have tachycardias
(abnormally fast heartbeat) as
the underlying medical cause of
their problem," says Dr. Stein-
man, Director of Clinical Elec-
trophysiology. It is very important
President of Ambulatory and
Cardiovascular Services.
Sinai Hospital is committed to
supporting ongoing research like
that of the EP team, a commit-
ment that helps lead the way to
state-of-the-art patient care. It is
that long- standing devotion and
dedication to standards of excet-
lence that keep Sinai positioned
to offer improved preventive med-
icine, enhanced patient care and
important contributions to the
field of medicine and medical
education.
Sinai's Cardiovascular Fitness Center offers both cardiac
rehabilitation for heart patients and a Health and Wellness
program to stay fit.
lems non-surgically. Flexible tubes called catheters can
be threaded up the arteries through a tiny surgical
opening, usually in the groin.
At the end of the tube, a device can cut away the
blockage in a procedure called an atherectomy; com-
press the blockage against the artery's walls in a pro-
cedure called balloon angioplasty; or clear and keep
open the clogged area by implanting a stent, which pro-
vides support in keeping the artery open.
"Traditionally, if a patient had trouble with a stub-
born, clogged vessel, the only thing to do was pray and
call your friendly surgeon," recalls Wassim E. Nona,
M.D., director of Sinai's Cardiology Intensive Care Unit.
"Now you have a choice.
"For example, I was performing an atherectomy on
a 51-year-old man recently. I wasn't convinced that we
had cleared out his clogged artery enough to ensure
long-term success. Today's expectations are higher than
they once were. So I put in a stent. The patient went
home three days later and he's doing great."
At Sinai's cardiac cath lab, the gleaming, modern
equipment is only one component of a standard for
excellence. The physicians — known as interventional
cardiologists — are highly trained in catheterization
techniques and the use of the newest devices. Their
extensive experience and expert knowledge prepares
them to make exactly the right treatment choice for
each patient.
"Each of these cardiac catheterization devices has
its specific use," sayS Cardiologist Alan J. Silverman,
D.O. "Among other things, the physician must con-
sider the type of lesion and the artery where the block-
age is located. The physician must have a current
continues on page 6
S PECIAL ADVERTISEMENT
ormally each beat of the
heart occurs in response
to a regular electrical im-
pulse. When these im-
pulses become erratic,
the heartbeat may become too
fast, too slow or irregular — a con-
dition generally known as ar-
rhythmia. Recently publicized
cases of irregular heartbeat in-
clude those of former Detroit
Mayor Coleman Young, who was
treated at Sinai, and former Pres-
ident George Bush.
Sinai Hospital not only has an
impressive team of cardiovascu-
lar experts on staff who deal
primarily with the heart's
"plumbing" problems, in which
arteries and vessels, like pipes,
become blocked and re-
strict the flow of blood.
Sinai also has a special
multidisciplinary team of
healthcare professionals
dedicated to treating the
heart's "electrical" mal-
functions. The team is
comprised of five electro-
physiologists, cardiologists
with specific training in
heart rhythm disorders.
Russell Steinman, M.D.;
Michael Lehmann, M.D.;
John Baga, M.D.; Luis
Pires, M.D.; and Claudio
Schuger, M.D., work close-
ly with nurses, technicians
and engineers who spe-
cialize in treating patients
with electrical problems of
the heart.
Careful, productive research
with arrythmia patients has
brought this team to the forefront
in the diagnosis and treatment of
cardiac arrhythmias. As in Jere-
my's case, children suffering from
hereditary Long QT Syndrome
experience a prolonged electrical
recovery of their hearts between
beats, which can lead to attacks
of rapid heartbeat that, in turn,
may result in fainting, seizures
and even cardiac arrest and
death. Unfortunately, the gene
for this disorder is dominant, so